overweight, obesity and physical inactivity

8/14/2019 Overweight, Obesity and Physical Inactivity

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OVERWEIGHT, OBESITYAND PHYSICAL INACTIVITY

RECOMMENDATION 4 Using the questions below, determine and record diet quality/dietary

habits

1. Do you usually eat breakfast?

2. Do you usually* eat 5 or more servings of fruit and vegetables/day

3. Do you usually* choose whole grain products?

4. Do you usually* choose low fat or reduced fat alternatives at home and when eating out?

5. How many boxes, cups or cans of fruit juice or pop do you usually drink per day?What do you drink when you are thirsty?

More than one no answer and more than one serving of sweetened beverage per day indicates the

need for nutritional advice from the physician or referral to a registered dietitian or Dial-A-Dietitian

(1 800 667-3438)

*indicate to the patient that usually means 5 or more days of the week, most weeks.

RECOMMENDATION 5 Assess factors that may inuence weight, activity level

and risk levels

1. Ask about family history of overweight, diabetes, high cholesterol, heart disease, hypertension andkidney disease

2. Consider associated health conditions:

Children/youth Adult

Depression Hypertension

Asthma Type 2 diabetes

Being bullied Arthritis

Learning difculties Depression

Type 2 diabetes

3. Assess social conditions

poverty

unemployment/employment issues

education level

workplace and home stresses

current or previous abuse

4. Further diagnostic assessment should be individualized based on risk factors and family history.

Extensive laboratory assessment of overweight, obese and physically inactive patients in the

absence of obvious risk factors or physical ndings is rarely fruitful.

RECOMMENDATION 6 Adults: Assess each individuals readiness for change.

Tailor interventions and support to their current situation

(See Appendix 2)

1. Educate adults about the risks of excess weight and the benets of moderate weight loss and

increased activity. Reinforce the message that even modest weight loss and increased activity can

confer signicant health benets. Increases in physical activity in a stable, overweight person likely

confer greater health advantages than diet in a physically inactive person.


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2. Assess readiness to change: Ask the following questions:

Are you considering trying to lose weight or increase activity?

Are you currently trying to lose weight or increase activity?

Would you like some information to help you?

3. Help the patient who is ready to change to set realistic goals:

Emphasize gradual change in lifestyle over time

Recommend increased physical activity (e.g. walking 30 minutes/day) Recommend some level of caloric restriction

Provide self-help materials

Praise success

See Appendix 2 for detailed explanation of stages of change

Physicians are encouraged to provide brief lifestyle advice during the management of

other conditions whenever an opportunity is available and appropriate.

RECOMMENDATION 7 Children and youth-assessment and management

Assessment and management will require:

the involvement of parents or care-givers where possible and may require formal nutritional

counseling by a registered dietitian and or pediatric referral

an understanding and sensitive approach to assessment of potential eating disorders

With growing children and youth, the goals may be weight maintenance and increased

activity while normal linear growth occurs.

RECOMMENDATION 8 Drugs/popular diets/surgical treatment (adults)

1. Pharmacological treatments are of limited benet and have frequent side effects. The long term

benets are unknown. There may be limited use of one agent in adolescence.

2. Popular diets are becoming extremely prevalent and controversial. Evidence shows that over thelong term, their efcacy is due to caloric decit (energy in and out) and duration. Diets that are

restrictive in particular food groups offer no long-term benet and impose considerable risk of

micronutrient deciencies.

3. The surgical treatment of obesity involves risks and complications. Patients should only consider

surgery if their BMI is greater than 40 or if it is greater than 35 and there is a related condition such

as hypertension, type 2 diabetes or cardiovascular disease.

4. Very frequent weigh-in sessions (for example, weekly visits) have shown no long term benets.

Rationale

Obesity in adults is indicated by a body-mass index (BMI) of 30 or more. About 33% of adult

Canadians had a BMI greater than 25 (overweight) and 14.9% had a BMI of >30 in 20031. The Brit-ish Columbia Nutrition Survey showed that 56% of British Columbians are overweight or obese2. The

prevalence of obesity in both children and adults has been increasing in BC and throughout Canada in

children, adolescents and adults 2,3,4. Obesity is a major risk factor for hypertension, type 2 diabetes,

dyslipidemia, gallbladder disease, cancer and cardiovascular disease 5.

Physicians and patients have requested a coherent reproducible approach to medical assistance in

the management of obesity and inactivity. Recommendations for screening and intervention for obesity

have recently been developed by the American College of Family Physicians5. The recommendations


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focus on using BMI as an indicator of obesity and advice regarding weight loss, increased physical

activity and the risk of more serious diseases. Efforts to reduce calorie and fat intake have been shown

to cause weight loss, particularly if they are applied together with a physical exercise program.

The American Academy of Pediatrics has provided some recommendations for the prevention of

pediatric overweight and obesity6 . The Canadian Pediatric Society, the College of Family Physicians,

Dietitians of Canada and the Community Health Nurses Association have prepared a summary regard-

ing the use of growth charts in Canadian infants and children 7. Although therapeutic options remainto be optimized, behavioural approaches that involve the child and family have demonstrated success.

The recommendations suggest as a guideline that children and adolescents should be considered

overweight if they are between the 85th and 95th percentiles using Centers for Disease Control (CDC)

growth charts8,9. Obesity in children and youth is a BMI for age of greater than the 95th percentile.

Physicians can use clinical judgment to address overweight and obesity in children and adolescents

and to advise them about the benets of weight loss, increased physical activity and increased risk of

complications.

Recent evidence indicates that adult BMI of between 25 and 30 is not associated with increased

mortality. Attempts at intervention should focus on more overweight 27 with comorbidities such as

hypertension or diabetes and obese patients, particularly those with comorbidities10.

References

1. Statistics Canada Health Indicators. June 2004.

2. British Columbia Ministry of Health Services. British Columbia Nutrition Survey. Report on Physical

Activity and Body Weight. March 2004.

3. Katzmaryk PT. The Canadian obesity epidemic, 1985-1998. CMAJ 2002;166:1039-1040.

4. Tremblay MS and Willms JD 2000. Secular trends in the body mass index of Canadian children

CMAJ 2000;163:1429-33.

5. McTigue KM, Harris R, Hemphill B et al. Screening and intervention for obesity in adults: Summary

of the evidence for the US Preventive Services Task Force. Ann Intern Med 2003;139:933-949.

6. American Academy of Pediatrics. prevention of pediatric overweight and obesity.Pediatrics 2003;112: 424-430.

7. Canadian Paediatric Society. Use of growth charts for assessing and monitoring growth in

Canadian infants and children: Executive summary. Paediatr Child Health 2004;9:171-173.

8. Centres for Disease Control 2005. http://www.cdc.gov/nchs/about/major/nhanes/

growthcharts/charts.htm9. Cole TJ, Bellizzi MC, Flegal KM and WH Dietz. Establishing a standard denition for child over-

weight and obesity worldwide: international survey. BMJ 2000;320:1-6.

10. Flegal KM, Graubard BI, Williamson DF and MH Gail. Excess deaths associated with underweight,

overweight and obesity. JAMA 2005;293:1861-67.


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Sponsors

This guideline was developed by the Guidelines and Protocols Advisory Committee, approved by the

British Columbia Medical Association and adopted by the Medical Services Commission. Partial fund-

ing for this guideline was provided by the Health Canada Primary Health Care Transition Fund.

Effective Date: September 1, 2005

This guideline is based on the scientic evidence at the time of the effective date.

The principles of the Guidelines and Protocols Advisory Committee are:

to encourage appropriate responses to common medical situations

to recommend actions that are sufcient and efcient, neither excessive nor decient

to permit exceptions when justied by clinical circumstances.

Guidelines and Protocols Advisory Committee

1515 Blanshard Street 2-3

Victoria BC V8W 3C8

Phone: (250) 952-1347 E-mail: [email protected]

Fax: (250) 952-1417 Web site: www.healthservices.gov.bc.ca/msp/protoguides

G&P2005-098


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Appendix 1

International BMI (kg/m2) by age and sex

(overweight > 85th percentile and obese >95th percentile9)

Appendix 2 Stages of Change

PRE-CONTEMPLATION

Person may be unaware of health consequences of increased weight or inadequate activity. May be

resistant due to past failures.

Provide non-judgemental information and advice on health consequences of increased weight orinadequate activity

Tools: Provide patient resources for reducing sedentary activity, increasing activity level and healthy

eating using one-page handouts and brief advice.

Dialogue: I am concerned about your weight. Losing some weight could really help you feel

better and help your health. Would you like to read some information about why

reducing your weight or increasing your activity level is important to your health?

CONTEMPLATION

Person is aware of problem, but not yet ready to change their behaviour/lifestyle

Provide encouragement, positive support, and focus on health consequences of excess

weight/inactivity.

Tools: share examples of people who have successfully increased activity/lost weight. Encourage

self-evaluation focussing on the pros and cons of changing.

Dialogue: Lets consider the benets of weight loss and what you might need to do.

6 17.6 19.8 17.3 19.7

7 17.9 20.6 17.8 20.5

8 18.4 21.6 18.4 21.6

9 19.1 22.8 19.1 22.8

10 19.8 24.0 19.9 24.1

11 20.6 25.1 20.7 25.4

12 21.2 26.0 21.7 26.7

13 21.9 26.8 22.6 27.8

14 22.6 27.3 23.3 28.6

15 23.3 28.3 23.9 29.116 23.9 28.9 24.4 29.4

17 24.5 29.4 24.7 29.7

18 25.0 30.0 25.0 30.0

BOYS GIRLS

Overweight Obese Overweight Obese

AGE

(yrs)


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PREPARATION

The person is ready to change but is uncertain how to get started

Provide support and encouragement, offer information, options and referrals as necessary. Emphasize

the success of gradual incremental change.

Tools: Provide appropriate resource information. Assist in negotiating a plan and setting realistic goals

and timelines.

Dialogue: What two changes do you feel you could you make in your eating habits/activities

this week to start you in the right direction?

ACTION

Person feels empowered to reach goals, and is actively learning or trying new behaviors.

Engagement strategy: develop and discuss strategies to increase activity improve eating habits, afrm

positive changes and encourage modications to behaviour and lifestyle.

Tools: identify community-based and professional programs that will provide support for lifestyle

changes. Assist individual to develop a relapse prevention plan. Encourage them to exercise with a

partner or join a group with similar goals.

Dialogue: Its great to see you making such positive changes. How are you feeling? Have you

run into any problems or difculties? What did you do about that?

RELAPSE

Person feels discouraged and helpless, doesnt feel they have been successful

Engagement strategy: Acknowledge the difculties of real change over time, provide hopeful empathic

support, and encourage them to tryagain.Emphasize again the need for gradual sustained change

over the long term.

Tools: Support with problem solving, identifying realistic goals.

Dialogue: What were the positive changes you tried? What were the tough things to manage?

Every time you make an effort to improve your nutrition and activity you learn somenew things that will help you next time.

MAINTENANCE

Person has made positive lifestyle changes; life skill development and support systems are rened.

Engagement strategies: continue with relapse prevention strategies, provide objectivity and perspective

on accomplishments at time of despair or plateau, discuss and normalize life challenges.

Tools: acknowledge successes, continue to offer support and encouragement and problem solving

help. Normalize the difculties in maintaining weight loss and activity levels in the context of aging,

busy lives, school and family demands.

Dialogue: Tell me how you manage to continue your healthy eating/exercise when you are

ill/busy/stressed/tired? What helps you stay on track?


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152

155

157

160

163

165

168

170

173

175

178

180

183

185

188

191

193

Kg

Lbs

Height

(cm)

Height

(ft/in)

Weight

50

51

52

53

54

55

56

57

58

59

510

511

60

14

14

15

16

16

17

18

18

19

20

20

21

22

22

23

24

24

25

26

26

27

28

28

29

30

61

13

14

15

15

16

16

17

18

18

19

20

20

21

22

22

23

24

24

25

26

26

27

28

28

29

62

13

13

14

15

15

16

17

17

18

19

19

20

21

21

22

22

23

24

24

25

26

26

27

28

28

63

12

13

14

14

15

16

16

17

17

18

19

19

20

21

21

22

22

23

24

24

25

26

26

27

27

64

12

13

13

14

15

15

16

16

17

18

18

19

19

20

21

21

22

23

23

24

24

25

26

26

27

BMI6yrs

kg

20

21

22

23

24

2

26

27

28

29

30

31

32

33

kg

lbs

44

46

48

5

53

5

57

59

62

64

66

68

71

73

lbs

Height(inches

29

39

72

Height (cm)

31

34

35

37

39

40

77

33

30

31

33

34

36

37

39

40

82

35

26

28

29

30

32

33

34

36

37

38

40

87

37

24

25

26

27

28

30

31

32

33

34

35

37

38

39

92

39

21

22

23

24

26

27

28

29

30

31

32

33

34

35

97

41

19

20

21

22

23

24

25

26

27

28

29

30

31

32

102

43

17

18

19

20

21

22

23

24

24

25

26

27

28

29

107

45

16

17

18

18

19

20

21

22

22

23

24

25

26

26

112

47

15

15

16

17

18

18

19

20

20

21

22

23

23

24

117

49

13

14

15

15

16

17

17

18

19

19

20

21

21

22

122

51

12

13

14

14

15

16

16

17

17

18

19

19

20

20

127

53

11

12

13

13

14

14

15

15

16

17

17

18

18

19

132

55

11

11

12

12

13

13

14

14

15

15

16

17

17

18

137

57

10

10

11

11

12

12

13

13

14

14

15

15

16

16

142

59

9

10

10

11

11

12

12

12

13

13

14

14

15

15

147

Mass

kg

34

35

36

37

38

39

40

41

42

43

44

45

46

47

kg

lbs

75

77

79

82

84

86

88

90

93

95

97

99

101

103.4

lbs

Height(inches

37

40

92

Height (cm)

39

36

37

38

39

40

41

97

41

33

34

35

36

37

37

38

39

40

102

43

30

31

31

32

33

34

35

36

37

38

38

39

40

107

45

27

28

29

29

30

31

32

33

33

34

35

36

37

37

112

47

25

26

26

27

28

28

29

30

31

31

32

33

34

34

117

49

23

24

24

25

26

26

27

28

28

29

30

30

31

32

122

51

21

22

22

23

24

24

25

25

26

27

27

28

29

29

127

53

20

20

21

21

22

22

23

24

24

25

25

26

26

27

132

55

18

19

19

20

20

21

21

22

22

23

23

24

25

25

137

57

17

17

18

18

19

19

20

20

21

21

22

22

23

23

142

Mass


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Appendix 5


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Appendix 6


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Healthy Active Living

A GUIDEFOR PATIENTS

Increasing physical activity and reducing body fat around the waist decreases the risk of

hypertension, diabetes, heart disease, stroke and kidney failure. For example, increasedactivity of more than 2.5 hours of walking per week reduces the risk of heart disease by 40%.

The benet was seen for all ages, in different ethnic groups and regardless of whether a

person was normal or overweight.

Diet

1. Eat a healthy breakfast

2. Eat 5 or more servings of fruit and vegetables per day

3. Choose whole grain products

4. Choose low fat or reduced fat alternatives at home and when eating out

5. Reduce boxes, cups or cans of fruit juice or pop to no more than 1 per day.

6. Choose water when thirsty

Recommended activity level

Children and youth 30-90 minutes per day

Adults 30 minutes per day

Tips to increase activity level

Children and Youth

increase the amount of time currently spent being physically active by at least 30 minutes more

per day

decrease the time spent watching TV, playing computer games and surng the Internet by at least30 minutes less per day

Adults

Create a new morning exercise routine with 10 minutes of exercise

Park the car 10 minutes walking distance from work or shopping area

Go for a bike ride

Do a physical activity routine in front of the TV

Expected yearly weight loss with additional activity

kg lb

Weight 50 kg: moderate walk (30 min/day) 5 11

brisk walk (30 min/day) 6.2 14

Weight 70 kg: moderate walk (30 min/day) 7 16

brisk walk (30 min/day) 8.75 20

(110 lb)

(155 lb)


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Resources

BC HealthGuide OnLine has a world of health information just a click away, through the award-

winning Healthwise Knowledgebase. Over 2500 detailed symptom and condition-based

topics are available, including topic overviews, check your symptoms, when to see a doctor,

home treatments, and tips and tools for healthy living. Information specic to B.C. is also

available, including the BC HealthFiles. Web site: http://www.bchealthguide.org

Chronic Disease Self-Management Program

A patient education program offered in communities throughout British Columbia that teaches

practical skills in managing chronic health problems.

Toll-free in B.C.: 1 866-902-3767

Canadian Health Network

Canadian Health Network is Canadas national health information network. Start your search here

for health information developed by leading Canadian health organizations and international healthinformation providers. Web site: http://www.Canadian-health-network.ca

Government-listed Health-Related Internet Resources

This page provides links to other health-related Internet sites. These information resources have been

selected by the Health and Human Services Library to serve the information needs of government

staff and stakeholders.

Diet and Nutrition

Dial-A-Dietitian is a free nutrition information line for B.C. residents. It specializes in easy-to-use

nutrition information for self-care, based on current scientic sources. Dietitians provide brief nutrition

consultation by phone. This is an excellent source of information about special diets for people withchronic illnesses, such as diabetes and cardiovascular atherosclerotic disease.

Toll-free in B.C.: 1 800 667-3438

Greater Vancouver: 604 732-9191

Exercise

Canadas Physical Activity Web site: www.paguide.com

Health Canadas online guide is designed to help you make wise choices about physical activity that

will improve your health, help prevent disease, and allow you to get the most out of life. If you think

your congestive heart failure might prevent you from becoming more active, check out the Physical

Activity Readiness Questionnaire.

Call 1 888 334-9769 for a free activity guide.

overweight, obesity and physical inactivity

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